Role of multi-row detector CT enterography in evaluation of small bowel disorders

ABSTRACT

Imaging diagnosis of small bowel diseases has long been technically challenging. Imaging techniques included plain radiography, contrast studies, computed tomography [CT], magnetic resonance imaging [MRI], sonography, scintigraphy and angiography. Multi-row detector CT [MDCT] enterography is a new technique that improved depiction and characterization of small bowel pathology. To assess the role of multi row detector computed tomography [CT] enterography in evaluation of small bowel disorders. The study was conducted on 30 patients suffering from known or suspected small intestinal disease and subjected to CT enterography using multi-detector row CT and iso-osmotic mannitol as neutral enteric contrast material. CT showed symmetrical mural and mucosal changes in 12 patients, seven of them associated with comb sign and creeping fat sign proved to be Crohn's disease and five patients without specific features due to Crohn's, ulcerative colitis, typhoid colitis, ileitis sequel to complicated appendicitis and typhlitis with ileitis. CT showed symmetrical thickening, grey attenuation pattern and aneurysmal dilatation proved to be lymphoma in three patients. CT showed vascular occlusion and mural changes in two patients. CT showed hyperattenuating lesion in two patients due to bowel wall hematoma, CT showed asymmetrical thickening in four patients, two of them showed infiltrative mesenteric mass with calcifications and desmoplastic reaction proved to be due to carcinoid tumour. One patient with asymmetrical thickening showed strongly enhancing lesion in the enteric phase in the second part of duodenum proved to be periampullary carcinoma. The fourth patient with asymmetrical thickening showed heterogeneous enhancement in the venous at distal heal loop with mesenteric stranding, lymph adenopathy and liver deposit proved to be due to adenocarcinoma. CT showed dilated bowel loops with transitional zone in two patients proved to be due to intestinal obstruction, There were five patients with unremarkable CT features that were followed up without definite lesion. CT enterography with iso-osmotic mannitol is a simple, non invasive, economic, effective method for assessing small bowel disease and can replace other imaging modalities